LABORATORY DIAGNOSIS OF TWO SCRUB TYPHUS OUTBREAKS AT CAMP FUJI, JAPAN IN 2000 AND 2001 BY ENZYME-LINKED IMMUNOSORBENT ASSAY, RAPID FLOW ASSAY, AND WESTERN BLOT ASSAY USING OUTER MEMBRANE 56-KD RECOMBINANT PROTEINS

JU JIANG Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland; United States Navy Environmental Preventive Medicine Unit No. 6, Pearl Harbor, Hawaii; PANBIO Limited, Brisbane, Queensland, Australia

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KAREN J. MARIENAU Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland; United States Navy Environmental Preventive Medicine Unit No. 6, Pearl Harbor, Hawaii; PANBIO Limited, Brisbane, Queensland, Australia

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LAUREL A. MAY Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland; United States Navy Environmental Preventive Medicine Unit No. 6, Pearl Harbor, Hawaii; PANBIO Limited, Brisbane, Queensland, Australia

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H. JAMES BEECHAM III Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland; United States Navy Environmental Preventive Medicine Unit No. 6, Pearl Harbor, Hawaii; PANBIO Limited, Brisbane, Queensland, Australia

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RAY WILKINSON Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland; United States Navy Environmental Preventive Medicine Unit No. 6, Pearl Harbor, Hawaii; PANBIO Limited, Brisbane, Queensland, Australia

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WEI-MEI CHING Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland; United States Navy Environmental Preventive Medicine Unit No. 6, Pearl Harbor, Hawaii; PANBIO Limited, Brisbane, Queensland, Australia

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ALLEN L. RICHARDS Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland; United States Navy Environmental Preventive Medicine Unit No. 6, Pearl Harbor, Hawaii; PANBIO Limited, Brisbane, Queensland, Australia

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Two scrub typhus outbreaks occurred among U.S. Marines training at Camp Fuji, Japan, between October 25 and November 3, 2000 and October 17 and November 30, 2001. Nine cases in approximately 800 Marines in 2000 and eight cases in approximately 900 Marines in 2001 (approximate attack rates = 1.1% and 0.9%, respectively) reported with signs and symptoms of fever, rash, headache, lymphadenopathy, myalgia, and eschar. Serologies and rapid response to doxycycline treatment indicated they had scrub typhus. Sixty-four convalescent serum samples (18 suspected cases and 46 negative controls) from U.S. Marines training at Camp Fuji during the outbreaks were assessed by enzyme-linked immunosorbent assay (ELISA), rapid flow assay (RFA), and Western blot assay for evidence of infection with Orientia tsutsugamushi, the causative agent of scrub typhus. All but one suspected case had serologic evidence of scrub typhus and all 46 control sera were non-reactive to O. tsutsugamushi antigens. The recombinant 56-kD antigen (r56) from the Karp, Kato and Gilliam strains of O. tsutsugamushi in an ELISA format provided better results than Karp r56 alone (ELISA and RFA) or whole cell antigen preparation from Karp, Kato and Gilliam (ELISA).

Author Notes

Reprint requests: Allen L. Richards, Rickettsial Diseases Department, Naval Medical Research Center, 503 Robert Grant Avenue, Room 3A19, Silver Spring, MD 20910-7500, Telephone: 301-319-7668, Fax: 301-319-7460, E-mail: RichardsA@nmrc.navy.mil.
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